2610Ethics Final Readings.docx

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Department
Health Sciences
Course
Health Sciences 3250F/G
Professor
Bill Irwin
Semester
Fall

Description
ETHICS FINAL READINGS Reproductive Rights and Technologies ­ Abortion o Conservative: a human being exists from the time of conception and has the same right to life as any other human o Moderate position: fetus does not have equal right to life until it has reached viability, the capacity to survive outside the womb o Similar position: right to life depends on sentience, the capacity to experience pleasure and pain o Liberal view: abortion is morally permissible even in the later stages of pregnancy ­ Thompson makes two important points on abortion o Argues that abortion is generally permissible, but not always  Distinguishes between rape vs. voluntary sex o Also argues, that although it is permissible to detach ones body from the fetus through abortion, it is not permissible to guarantee the death of the baby once it is born.  The right to an abortion does not entail a right to commit suicide ­ Negative right of one individual implies an obligation for other individuals not to interfere with the expression of that right ­ Positive right implies an obligation for others to support or facilitate its expression ­ Negative right outweighs positive because the right to be harmed has more moral weight than the right to be benefited. - Marquis - Claims that the wrongness of killing adults extends to the wrongness of - Abortion is a prima facie morally wrong, but not absolutely wrong. In some instances the harm from not aborting is just as great as the harm aborting - Ex carrying to term a severely deformed fetus with a poor quality life Killing is wrong because it deprives the victim of a valuable future, but the future is not valuable itself if the individual does not have the capacity to experience things. ­ Marquis believes the moral permissibility of abortion hinges on the moral status of the fetus. It has this moral status when it possesses the property of a valuable future. ­ Two senses of potential (pg. 77) ­ There are Marquis (impermissible) and Thompsons (permissible) views on abortion but also a more moderate position that is more widely accepted o In this view killing early stage fetuses would be permissible but killing late stage would not. ­ Ronald Dworkin claims that moral objections to abortion rest on people’s belief in the sanctity of human life. o The sanctity of life principle says that every human life has intrinsic value, independent of whether it is valued by or is good for anyone. Killing even an early stage fetus violates the sanctity and value it embodies and therefore is wrong. The Moral Status of Embryos ­ Many opponents of abortion apply the same reasoning to embryos that they apply to fetuses. Argue that embryos have the potential to become persons and that this potential gives moral status to embryos that protects them from being destroyed or created for the purpose of stem cell research. ­ Because embryos lack identity preserving potential and moral status it would not be wrong to prevent their development into fetuses and persons ­ As a matter of consistency, if both embryos and male and female gametes have the potential to develop into human beings, and if preventing embryos from further development is morally wrong, then contraception is also morally wrong. ­ IVF has potential to create genetic mutations, disease etc.… ­ Events or processes in the lab dish or liquid nitrogen container can damage embryos and adversely affect future people. An embryo has moral status not in the intrinsic sense of a right to life but in the extrinsic sense of a persons right not to be harmed by the consequences of events occurring at he embryonic stage. ­ IVF is expensive, not everyone can afford this procedure. Is that fair? Surrogate Pregnancy ­ Woman is artificially inseminated with the sperm of a man who she is not married to and brings it to term. ­ When the baby is born it is given to another woman ­ When the surrogate contributes the egg from which the fetus and baby develops, she is both the child’s genetic and gestational mother. ­ When the surrogate accepts the money in the contract and delivers the child to the contracting parents she is giving up her parental right to have a relationship with that child. ­ Ultimately the main ethical concern is the welfare of the child. This reinforces that it is the social mother more so than the genetic or gestational mother that is most important. Sex Selection ­ Aborting fetuses based on the sex revealed by ultrasounds, sperm sorting, PIGD, and amniocentesis. ­ Ex. China aborting females – reinforces discrimination against women ­ There are some cases in which sex selection is morally permissible. Ex. hemophilia where it is mainly carried and expressed in male offspring. ­ Sex selection for family balancing. Have one boy and one girl is more rewarding to raise. o Nothing that says this is immoral Cloning ­ Inserting the nucleus of an adult human somatic cell into a human egg whose nucleus has been removed. Means that the cell created can develop into many different cell types (kidney, heart) ­ Therapeutic cloning has the ability to rejuvenate cells or even replace organs that are damaged from degenerative diseases. ­ Against it are those that say it is morally wrong to create embryos solely for the sake of research leading to therapy ­ Embryo right to life vs. improving quality of life of someone suffering from disease ­ Reproductive cloning aims to make full-fledged human beings from these embryos ­ Sexual forms of reproduction seem more able than asexual to prevent genetic mutations Chapter 5 – Genetics Genetic Testing and Screening ­ Diseases with genetic cause can be divided into three types o Monogenic: mutation in a single gene ex. Cystic fibrosis, Huntington’s  Autosomal dominant (inherited from either parent, mutation in one copy of gene)  Autosomal recessive (mutation in two copies of gene)  Sex linked (traceable to X or Y chromosome) o Polygenic: mutations in several or more genes ex. Cancer o Multifactorial: caused by interaction of several or more genes and the environment (most diseases) ­ Genetic testing is designed for individuals who are known to be at risk of having a genetic disorder with a familial mode of inheritance ­ Genetic screening is designed to test members of a particular population for a disorder for which there may be no family history or other evidence of its presence ­ Testing and screening is usually presymptomatic ­ One danger in this is that insurers or employers might discriminate against them based on their genetic information. Insurance operates on the idea of pooling risks and the genetically tested with disease might be rejected in applying for health insurance ­ Employers must dismiss or not hire people who have tested positive for a mutation that predisposes them to a given disease ­ Offers people with predisposed risk of a disease the opportunity to make informed choices o If a father tested positive for Huntington’s disease (50%) he would be obligated to tell his children b/c it would prevent harm by allowing his children to make a decision whether they want to have children and pass it on, as well, enable them to plan other aspects of their life accordingly ­ BRCA1 and BRCA2 genes have high risk associated with breast cancer (85%) o If she had no siblings or children she would not be obligated to get tested o If she had siblings or children and got diagnosed with breast cancer she would be obligated to test and confirm the mutation ­ Tay Sachs is a recessive disorder that causes no signs until around the age of 1, and children usually only live until the age of 3 or 4 ­ Usually people are tested as a teenager so they can make future plans like marriage, children etc. based on this knowledge ­ PKU is a recessive disorder that causes mental retardation due to inability to metabolize amino acid phenylalanine. With the proper diet, mental retardation can be avoided and in this case genetic screening is highly useful case Preimplantation Genetic Diagnosis ­ Selecting IVF embryos on the basis of their genetic status. (Can be tested for disease before implantation in the uterine wall) ­ Parents may be morally obligated to choose embryos without genetic mutations- as a means of preventing diseases (morally justified on the grounds of non-maleficence (requires that we not harm people by causing them to experience significant pain/suffering over the balance of their lives) and justice (we not deny people the same opportunities for achievement and well being that are open to others who are healthy or have only moderate disease). Implies that it is morally wrong to subject a person to exist with a severe disease when it is possible to cause a diff. person to exist without disease ­ Parents DO NOT have an obligation to provide their children with the best possible life; they just need a minimally decent life with adequate opportunities for achievement. Obligation is not grounded on perfectionism, just non-malificence and justice. ­ Need a threshold for late onset diseases o One way of measuring lifetime quality in severe late onset diseases is to compare the level of normal functioning per year lived with the level of pain, suffering, and disability per year lived. o Thus if parents could foresee this progression of a disease through PIGD of any embryo they would be obligated to prevent the life of a person who would have the disease ­ Four criteria will determine whether a life should be prevented by not selecting that embryo for implantation and subsequent birth o The probability of genotypic penetrance, or how likely it is that a genetic mutation will cause a disease o The severity of the symptoms of the disease o The time of onset of symptoms o The time between onset and death ­ Decisions about preventing lives with late-onset diseases that have been predicted by genetic testing of embryos should not be made lightly because the quality of a persons life in progress is shaped by his or her values and preferences o Ex. physical disability late in life could be extremely detrimental to someone who loves to dance/play sports vs. not as big a deal for someone who doesn’t o How can this decision be made on an embryo? ­ The suggestion is to select embryos with the best predictable health status but there is no obligation to make this selection o Ex. slightly impaired or disabled vs. healthy Gene Therapy ­ Somatic cell gene therapy involves correcting a mutated copy of a gene or inserting an additional normal copy of a gene into the cells of a person’s body. The aim is to treat genetically caused diseases in existing people ­ Germ line genetic alteration involves modifying the cells of gametes (sperm and egg) Form of disease prevention vs. gene therapy ­ Gene therapy is primarily relevant to single gene disorders and multifactorial diseases such as cancer o Recessive rather than dominant is easier o Recessive disorders might be treatable b/c inserting one normal copy of the gene into affected cells would be enough to ensure proper cell function o Dominant disorders would be treatable only by replacing the mutated copy of the gene with a normal copy o It is not presently possible to correct mutations but only to insert normal copies of genes into affected cells ­ Retroviruses are more effective than viral vectors in inserting genes into cell o Still poses risk for adverse immune response ­ Gene therapy using retroviruses has caused numerous deaths or led to cancer in the past, and so it is still preceding but with close monitoring and some restrictions o Rationale for preceding is b/c offer hope for children with fatal diseases o Precede on basis of beneficence, balanced by non-maleficence to minimize risks ­ Germ line would prevent diseases from happening in the first place o Difficult to weigh the potential health benefits of germ line intervention to people the present against any health burdens of this intervention to people in the future o This is not enough to prohibit this research but must be proceeded with caution and slowly until the efficacy of this intervention can be assessed more accurately Genetic Enhancement ­ Immunization would not be enhancement because the goal is to prevent disease ­ There is a gray area near the baseline of adequate functioning where it may be difficult to distinguish between treatment and enhancement o Intervention aimed at raising ones functioning to the baseline is a treatment o Intervention aimed at raising ones functioning above the baseline is an enhancement ­ Gives some people an unfair advantage over others with respect to competitive goods like beauty and intelligence ­ Enhancement is unfair because there is the financial component o Competitive goods like beauty and intelligence o Noncompetitive goods like adequate health ­ The dispositions that we cultivate on our own imperfect as they are, make our lives valuable to us. All these considerations may not be enough to constitute reasons for prohibiting genetic enhancement Eugenics ­ Can be defined as the use of science to improve the human genome ­ Universally regarded pejoratively due mainly to its association with Nazi Germany and sterilization programs in the United States and Canada in earlier twentieth century o Positive eugenics is the aim of genetic enhancement to improve peoples normal traits and capacities o Negative eugenics is when there is an obligation to prevent or control diseases ­ Some believe positive eugenics should be prohibited ­ People choosing mates with favorable physical and cognitive traits is a form of positive eugenics ­ PIGD and gene therapy are both forms of negative eugenics o Gene therapy motivated by the principle of beneficence o PIGD motivated by the principle of non-maleficence Chapter 6 – Medical Decisions at the End of Life ­ The use of the mechanical ventilator in the late 1960s redefined death ­ Doctors often must decide whether to withhold, withdraw, or continue life-sustaining interventions. These decisions are difficult because it is difficult to know in advance the long term benefits or burdens for the patient Defining Death ­ Ventilator allowed continued breathing and heartbeat though they lacked brain function o Should brain death be equated with death of the patient ­ Permanent loss of all brain functions should be the main criterion for determining death, because these functions are necessary for the integrated functioning of the organism as a whole o “Whole brain” criterion is now adopted but has been challenged ­ Some argue this criterion is physiologically inaccurate – the standard accounts that the brain controls and integrates all bodily processes, but some of the functions can continue for some time without brain function ­ Some argue that death should not be defined in terms of the whole brain, but instead when the higher brain necessary for consciousness permanently ceases to function o If the brain stem and structures other than the cortex continue to be active, then a human organism can continue to live after a person has died ­ Two definitions for death: one for persons and one for organisms o A body without the capacity for consciousness cannot have any interest in what happens to it and therefore cannot be harmed ­ Only scenario in which a patient can be harmed would be if at an earlier time he expressed a wish that his organs not be harvested once he permanently lost the capacity for consciousness. It would be a violation of consent and a form of posthumous harm ­ The whole brain criterion has broader legal and social importance for turning off the respirator ­ Cardiopulmonary and whole brain definitions ground clinical and legal practice ­ The whole brain is more clinically, legally, and socially acceptable and therefore is not likely to be replaced in the foreseeable future Withdrawing and Withholding Treatment ­ Withdrawing treatment (like removing a respirator) there is a person who performs the action and is responsible for death. (Person causes and event to occur) ­ Withholding life-sustaining treatment the person does not cause the patients death, presumably the cause of death is an underlying disease process running its normal cause (person allows an event to occur) ­
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